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Surgical Management of Primary Small Bowel NET Presenting Acutely with Obstruction or Perforation

  • Surgical Symposium Contribution
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Abstract

Up to 35% of small bowel neuroendocrine tumors (SBNETs) may present with an acute intra-abdominal complication including obstruction, perforation, bleeding or ischemia and may require emergency surgical treatment in centers not normally accustomed to managing patients with neuroendocrine tumors. These patients may have a known diagnosis of SBNET, be suspected as suffering from SBNET or have SBNET diagnosed as an incidental finding on presenting radiology or postoperative pathology. Perioperative priorities include obtaining both clinical and radiological staging with cross-sectional imaging and clinical examination, screening for the presence of carcinoid syndrome and right-sided cardiac disease and assessment of prognosis. Intraoperatively careful attention should be paid to noting the presence and location of multifocal primary and metastatic disease. Ideally, surgical resection with mesenteric lymph node dissection is the treatment of choice for obstructing and perforating lesions. Extended lymphadenectomy along the SMA, SMV and behind the pancreas should be primarily considered an elective procedure. In unwell patients with advanced disease surgical bypass (jejuno or ileocolic) or proximal defunctioning should be undertaken but, given the excellent long-term survivals in patients with stage IV disease, could be considered bridging procedures to elective resection following formal staging and multidisciplinary review.

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References

  1. Yao JC, Hassan M, Phan A et al (2008) One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26(18):3063–3072

    Article  Google Scholar 

  2. Abou Saleh M, Mansoor E, Anindo M et al (2019) Prevalence of small intestine carcinoid tumors: a US population-based study 2012–2017. Dig Dis Sci 64:1328–1334

    Article  Google Scholar 

  3. Manguso N, Gangi A, Nissen N et al (2018) Long-term outcomes after elective versus emergency surgery for small bowel neuroendocrine tumors. Am Surg 84(10):1570–1574

    Article  Google Scholar 

  4. Landry CS, Brock G, Scoggins CR et al (2008) A proposed staging system for small bowel carcinoid tumors based on the analysis of 6380 patients. Am J Surg 196:896–903 discussion 903

    Article  Google Scholar 

  5. Howe JR, Cardona K, Fraker DL et al (2017) The surgical management of small bowel neuroendocrine tumors: consensus guidelines of the north american neuroendocrine tumor society. Pancreas 46(6):715–731

    Article  Google Scholar 

  6. Akerstrom G, Hellman P, Hessman O et al (2005) Management of midgut carcinoids. J Surg Oncol 89:161–169

    Article  Google Scholar 

  7. Tolstrup M, Watt SK, Gögenur I (2017) Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy. Langenbecks Arch Surg 402:615–623

    Article  Google Scholar 

  8. Watzka FM, Fottner C, Miederer M et al (2016) Surgical treatment of NEN of small bowel: a retrospective analysis. World J Surg 40(3):749–758

    Article  CAS  Google Scholar 

  9. Pasquer A, Walter T, Hervieu V et al (2015) Surgical management of small bowel neuroendocrine tumors: specific requirements and their impact on staging and prognosis. Ann Surg Oncol 22(3):742–749

    Article  Google Scholar 

  10. Eriksson J, Garmo H, Hellman P et al (2017) The influence of preoperative symptoms on the death of patients with small intestinal neuroendocrine tumours. Ann Surg Oncol 24:1214–1220

    Article  Google Scholar 

  11. Boudreaux JP, Putty B, Frey DJ et al (2005) Surgical treatment of advanced-stage carcinoid tumors: lessons learned. Ann Surg 241(6):839–845

    Article  Google Scholar 

  12. Erikssin B, Kloppel G, Krenning E et al (2008) Consensus guidelines for the management of patients with digestive neuroendocrine tumors – well differentiated jejunal-ileal tumor/carcinoma. Neuroendocrinology 87:8–19

    Article  Google Scholar 

  13. Goumaa D, Gordon-Weeks A, Silva M (2018) Root of the mesentery and small bowel tumours also the domain of HOB surgeons: a single UK centre outcome. HPB 20(suppl 2):S547. https://doi.org/10.1016/j.hpb.2018.06.1988

    Article  Google Scholar 

  14. Hellman P, Lundström T, Öhrvall U et al (2002) Effect of surgery on the outcome of midgut carcinoid disease with lymph node and liver metastases. World J Surg 26(8):991–997. https://doi.org/10.1007/s00268-002-6630-z

    Article  PubMed  Google Scholar 

  15. Woodbridge LR, Murtagh BM, Yu DF et al (2014) Midgut neuroendocrine tumors: imaging assessment for surgical resection. Radiographics 34(2):413–426

    Article  Google Scholar 

  16. Sahani DV, Bonaffini PA, Fernández-Del Castillo C et al (2013) Gastroenteropancreatic neuroendocrine tumors: role of imaging in diagnosis and management. Radiology 266(1):38–61

    Article  Google Scholar 

  17. Moertel CG (1983) Treatment of the carcinoid tumor and the malignant carcinoid syndrome. J Clin Oncol 1(11):727–740

    Article  CAS  Google Scholar 

  18. Curan T, Tulin-Silver S, Patel K et al (2011) Prognostic clinicopathologic factors in longitudinally followed patients with metastatic small bowel carcinoid tumors. Pancreas 40:1253–1257

    Article  Google Scholar 

  19. Stueven AK, Kayser A, Wetz C et al (2019) Somatostatin analgues in the treatment of neuroendocrine tumors: past, present and future. Int J Molecular Science 120(12):167–181

    Google Scholar 

  20. Perry D, Hayek SS (2019) Carcinoid heart disease: a guide for clinicians. Cardiol Clin 37(4):497–503

    Article  Google Scholar 

  21. Pape U-F, Perren A, Niederle B et al (2012) ENETS consensus guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinoids. Neuroendocrinology 95:125–156

    Article  Google Scholar 

  22. Zandee WT, de Herder WW (2018) The evolution of neuroendocrine tumor treatment reflected by ENETS guidelines. Neuroendocrinology 106(4):357–365

    Article  CAS  Google Scholar 

  23. Landry CS, Lin HY, Phan A et al (2013) Resection of at-risk mesenteric lymph nodes is associated with improved survival in patients with small bowel neuroendocrine tumors. World J Surg 37(7):1695–1700. https://doi.org/10.1007/s00268-013-1918-8

    Article  PubMed  Google Scholar 

  24. Weber DG, Bendinelli C, Balogh ZJ (2014) Damage control surgery for abdominal emergencies. Br J Surg 101(1):e109–e118

    Article  CAS  Google Scholar 

  25. Partelli S, Bartsch DK, Capdevila J et al (2017) ENETS consensus guidelines for the standards of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours. Neuroendocrinology 105:255–265

    Article  CAS  Google Scholar 

  26. Boudreaux JP, Klimstra DS, Hassan MM et al (2010) The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas 39(6):753–766

    Article  Google Scholar 

  27. Younes M (2005) Frozen section of the gastrointestinal tract, appendix, and peritoneum. Arch Pathol Lab Med 129(12):1558–1564

    PubMed  Google Scholar 

  28. Laskaratos FM, Diamantopoulos L, Walker M et al (2018) Prognostic factors for survival among patients with small bowel neuroendocrine tumours associated with mesenteric desmoplasia. Neuroendocrinology 1:1–15

    Google Scholar 

  29. Norlen O, Stalberg P, Oberg K et al (2012) Long-term results of surgery for small intestinal neuroendocrine tumors at a tertiary referral center. World J Surg 36:1419–1431. https://doi.org/10.1007/s00268-011-1296-z

    Article  PubMed  Google Scholar 

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Acknowledgements

The CommNETS Surgical Section includes Dr Julie Hallett and Dr Calvin Law from the Susan Leslie Clinic for Neuroendocrine Tumors, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Dr Janice Pasieka, Tom Baker Cancer Center, Alberta, Canada; Dr Jonathan Koea, North Shore Hospital, Auckland, New Zealand; Dr Goswin (Win) Meyer-Rochow, Waikato Hospital, Hamilton, New Zealand.

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Authors and Affiliations

  1. Department of Surgery, Waikato Hospital, Private Bag 3200, Hamilton, 3204, New Zealand

    N. S. Rajaretnam & G. Y. Meyer-Rochow

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  1. N. S. Rajaretnam
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  2. G. Y. Meyer-Rochow
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The Commonwealth Neuroendocrine Tumor Research Collaborative (CommNETs) Surgical Section

  • Julie Hallett
  • , Calvin Law
  • , Janice Pasieka
  • , Jonathan Koea
  •  & Goswin Meyer-Rochow

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Correspondence to G. Y. Meyer-Rochow.

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The CommNETs Collaboration is supported by unconditional educational grant from Ipsen Canada and an unconditional grant from Ipsen Australia.

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This article is contribution to the Symposium entitled, “Surgical Dilemmas and Challenges for the Operating Surgeon in the Management of Small Bowel Neuroendocrine Tumours: A CommNETs Symposium”

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Rajaretnam, N.S., Meyer-Rochow, G.Y. & The Commonwealth Neuroendocrine Tumor Research Collaborative (CommNETs) Surgical Section. Surgical Management of Primary Small Bowel NET Presenting Acutely with Obstruction or Perforation. World J Surg 45, 203–207 (2021). https://doi.org/10.1007/s00268-020-05689-7

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  • DOI: https://doi.org/10.1007/s00268-020-05689-7

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